Lasik, Pellucid Marginal Degeneration, X-Linking, Ectasia, now 20/25 with GVR Scleral Lens

This patient has a 14 year history of multiple vision and ocular complications dating from 2002 to 2015. Because she wanted to see clearer while taking photos and videos under water this patient had LASIK surgery in her right eye in 2002. After the surgery her vision was good except for halos and starbursts at night. After 5 years this patient noted that the vision in her right eye began to decrease. In 2011, she was diagnosed with Anterior Basement Membrane disease and early cataracts. For several months she tried unsuccessfully to wear soft contact lenses. Also around this time she began noticing double vision. In 2013 this patient visited a well respected ophthalmologist in Houston who told her that she had a corneal deformity known as Pellucid Marginal Degeneration (PMD). In late 2013, this patient had Collagen Cross-Linking (CXL) done on her right cornea and a "pocket" CXL done on her left cornea. (Pocket CXL involves the use of a Femtosecond laser to make a "pocket" in the cornea where the active chemical is placed). For a 6 month period following these procedures, this patient suffered inflammations and corneal erosions in both eyes requiring 17 office visits. Following these visits, this patient had no functional vision in her left eye for several months. Following the CXL procedures, the same surgeon removed "several small bumps" (patient quote) from her left cornea using a small scalpel. After this was done this patient tried once again, unsuccessfully to wear soft lenses. When I first saw this patient in October, 2015, I diagnosed her with post-LASIK corneal ectasia in her right eye. Her left cornea was very distorted due to the "pocket" CXL. In addition, the laser used on her left cornea created a significant haze. This was the reason that this patient noted double vision in her left eye. At her initial visit, this patient's visual acuity was 20/50 in her right eye (with distortions) and 20/80 in her left eye (also with distortions). Over the last few months we were able to fit this patient with GVR Scleral lenses which are providing her with clear (20/25 vision in each eye) stable vision for the first time in many years. In the lower left photo, note the grey-white haze in the center of the cornea. This was created by the Femtosecond laser. The lower photo to the right is a cross-section of this patient's cornea (with a scleral lens over it) taken with Ocular Coherence Tomography (OCT). The 2 top curved lines represent the front and back surfaces of the scleral lens. The large, curved grey structure is the patient's cornea. Look carefully and you will note a short white line to the left of center of the cornea. This is the "pocket" created by the laser. The space between the back surface of the scleral lens and the front surface of the cornea is filled with unpreserved saline solution. I expect this patient to see clearly and comfortably with her scleral lenses for many years to come. She will never need to undergo corneal transplant surgery.

The Wavefront Scleral Lens

The corneal irregularities created by refractive surgeries, such as LASIK and RK, are responsible for ghosting, halos, starbursting, and loss of contrast sensitivity. These "higher order aberrations" may exist on both the anterior and posterior. With aberrometry, the defects of the entire optical system can now be corrected by a scleral lens.

The Wavefront Scleral Lens

Autologous Serum for Dry Eyes

Dry eye conditions are among the most challenging conditions faced by refractive surgery patients. With autologous serum, blood is spun down to plasma, forming an eye drop that helps rehabilitate the cornea.

Learn More about Autologous Serum

Dr. Boshnick on CBS This Morning

See Dr. Boshnick and Dr. Morris Waxler (former FDA chief research scientist on refractive surgery) talk about bad LASIK

Optimum Infinite Gas Permeable Material

I am happy to announce that our Global Vision Rehabilitation Center will be designing and fitting all of our “high need” patients with the Optimum Infinite gas permeable contact lens material. The Optimum Infinite material is the most oxygen permeable material ever to be approved by the FDA. In addition, this newly FDA approved material includes a UV lens blocker. Now for the first time, with certain patients, wearing a scleral lens made with the Infinite material under extended wear conditions can be considered.

SMAP 3D Scleral Lens Design

NEW: Powerpoint presentation on SMAP 3D

Last year we introduced an exciting piece of technology that has allowed us to custom design a scleral lens much more accurately. It is the SMAP 3D, which is a computer attached to a dedicated camera that allows us to obtain a 3 dimensional image of the entire front surface of the eye, including the cornea and the surrounding white portion of the eye (the sclera). Up until now there has not been any technology that would allow us to measure the ocular curvatures outside the cornea. The SMAP allows us to do this. Read More

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Blurred Vision, Burning Eyes: This Is a Lasik Success?

EyePrint Pro

EyePrintPro technology creates a scleral lens based on a mold of the cornea. The molding is accurate to 1 or 2 microns and fits perfectly because it exactly mirrors the irregularities of the individual corneal surface. The technology is well suited for post-Lasik, Keratoconus, RK, eye injury, and corneal transplant patients. Read More in this PDF about EyePrintPro Scleral Lens Technology

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